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https://www.readbyqxmd.com/read/28846532/randomized-trial-of-sternal-closure-for-low-risk-patients-rigid-fixation-versus-wire-closure
#1
Graham Graham, Jeevan Kumar, Shinya Unai, Diehl T James, Hitoshi Hirose Md
BACKGROUND: A previous retrospective analysis of our cardiac surgery patients showed shortened ventilation time and hospital stay among patients receiving rigid sternal fixation compared to sternal wire fixation. We performed a prospective randomized study to further investigate these outcomes and determine if rigid closure can provide reduced pain after cardiac surgery. METHODS: Patients undergoing cardiac surgery between July 2011 and May 2014 were prospectively randomized into wire closure (Group C) or rigid fixation using sternal plates (Group R) groups...
August 28, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28833518/post-sternotomy-mediastinitis-in-the-modern-era
#2
Siew S C Goh
BACKGROUND: Post-sternotomy mediastinitis is associated with significant mortality and morbidity. Despite surgical advances in cardiac surgery and improvements in perioperative care, mediastinitis remains a devastating post-operative complication. This study provides a comprehension review of post-sternotomy mediastinitis in the modern era, and discusses the incidence, risk factors, microbiology, prevention, and management of this complication. METHODS: This review was based on a PubMed/MEDLINE literature search up until 9th March 2017 for publications relevant to mediastinitis post-cardiac surgery...
August 22, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28832796/transverse-sternal-split-a-safe-mini-invasive-approach-for-perventricular-device-closure-of-ventricular-septal-defect
#3
Pankaj Garg, Arvind Kumar Bishnoi, Ketav Lakhia, Jigar Surti, Sumbul Siddiqui, Parth Solanki, Himani Pandya
Objective: Perventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique. Methods: Thirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance...
May 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28826681/relationship-between-right-ventricular-function-and-atrial-fibrillation-after-cardiac-surgery
#4
Pei-Chi Ting, An-Hsun Chou, Victor Chien-Chia Wu, Feng-Chun Tsai, Jaw-Ji Chu, Chun-Yu Chen, Tzuo-Yun Lan, Shao-Wei Chen
OBJECTIVE: The aim of this study was to explore the relationship between perioperative right ventricular (RV) function and postoperative atrial fibrillation (POAF) in the context of cardiac surgery. DESIGN: Prospective, observational study. SETTING: A single medical center setting. PARTICIPANTS: The study comprised 92 patients undergoing elective cardiac surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Consecutive patients without previous history of atrial fibrillation referred for cardiac surgery were enrolled prospectively...
May 10, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28790237/-prophylactic-effectiveness-of-vacuum-assisted-closure-for-high-risk-patients-undergoing-cardiovascular-surgery-through-median-sternotomy
#5
Ippei Takazawa, Yoshio Misawa, Satoshi Uesugi, Akira Sugaya, Hirohiko Akutsu, Souki Kurumisawa, Hirotaka Satoh, Arata Muraoka, Kei Aizawa, Shinichi Ohki, Koji Kawahito
Vacuum-assisted closure(VAC) therapy is mainly used for tissue defects. VAC therapy can remove exudate that could impair the healing process. We applied VAC therapy in patients considered at high risk of surgical site infection who underwent cardiovascular surgery via standard median sternotomy. Risk factors included advanced heart failure, obesity, diabetes mellitus, steroid administration, immunosuppressant administration, and chronic renal failure, etc. VAC therapy was used in 134 patients. Only 3 of these patients (2...
August 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28743654/endografting-under-assistance-of-transapical-body-floss-through-and-through-wiring-technique-and-rapid-ventricular-pacing-for-an-ascending-aortic-tuberculous-pseudoaneurysm
#6
Wan-Chi Chiang, Emily Ling-Lin Pai, Po-Lin Chen, Chun-Che Shih, I-Ming Chen
BACKGROUND: To demonstrate an ascending aortic tuberculosis pseudoaneurysm successfully treated with endografts under assistance of trans-apical body floss wiring technique and rapid ventricular pacing support. METHOD AND RESULT: A 77-year-old woman with a non-healing anteromedial chest wound presented with sudden hypotension and hemoptysis. The computed tomography (CT) scan revealed a 9-cm-diameter pseudoaneurysm of ascending aorta, with sternal erosion close to the wound...
July 23, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28734456/clamshell-closure-with-absorbable-sternal-pins-in-lung-transplant-recipients
#7
Anne Olland, Jérémie Reeb, Sophie Guinard, Joseph Seitlinger, Nicola Santelmo, Romain Kessler, Pierre-Emmanuel Falcoz, Gilbert Massard
Clamshell (bilateral anterolateral thoracotomy combined to transverse sternotomy) is an invasive surgical approach that is helpful in particular situations, especially bilateral lung transplantation. The closure technique remains challenging because clamshell incision can end with override, separation, or sternal pseudarthrosis complications. We describe the use of new absorbable sternal pins to stabilize the sternal closure and to help avoid additional sternal complications.
August 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28709667/routine-use-of-topical-bacitracin-to-prevent-sternal-wound-infections-after-cardiac-surgery
#8
Joshua L Chan, Andrada C Diaconescu, Keith A Horvath
BACKGROUND: The development of sternal wound infections remains a serious complication after cardiac surgery. A number of studies have assessed the use of topical antibiotics placed on the sternal edges. We evaluated the routine use of bacitracin ointment applied over the sternotomy skin incision as a prophylactic measure against sternal wound infections. METHODS: A retrospective review of all coronary artery bypass graft and valve surgery cases performed at a single institution between 2006 and 2015 was performed (n = 1,495)...
July 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28696877/multicenter-quality-improvement-project-to-prevent-sternal-wound-infections-in-pediatric-cardiac-surgery-patients
#9
Cathy Woodward, Richard Taylor, Minnette Son, Roozbeh Taeed, Marshall L Jacobs, Lauren Kane, Jeffrey P Jacobs, S Adil Husain
BACKGROUND: Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. METHODS: Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries...
July 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28645813/who-determines-the-timing-of-delayed-sternal-closure-the-surgeon-or-the-patient
#10
EDITORIAL
Todd C Crawford, Glenn J R Whitman
No abstract text is available yet for this article.
September 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28637255/a-biomechanical-study-of-4-different-sternum-closure-techniques-under-different-deformation-modes
#11
Suleyman Nazif Orhan, Mehmet Hamit Ozyazicioglu, Abdurrahim Colak
OBJECTIVES: This study experimentally compares the efficiency of the 4 most preferred sternal closure tehniques, in 3 different deformation modes of the chest. METHODS: Polyurethane sternum models fixed by conventional wiring, steel band, ZipFix band and figure-8 wiring are tested statically under lateral distraction, longitudinal shear and torsional deformation modes. As a result, load-deformation curves are obtained. The closure efficiency of the techniques is then compared with respect to allowable load (corresponding to 2 mm displacement), rigidity, rupture load and rupture displacement...
June 15, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28634566/adhesive-enhanced-sternal-closure-feasibility-and-safety-of-late-sternal-reentry
#12
Aaron J Spooner, Holly E M Mewhort, Lisa M DiFrancesco, Paul W M Fedak
This clinical case report describes sternal reentry performed years after adhesive-enhanced sternal closure using Kryptonite bone cement. This report provides novel data on the late effects of this innovation. We observed that sternal reentry is feasible and safe. The adhesive did not weaken from biodegradation over a period of several years. There was no evidence of adherence to adjacent soft tissues or other nonbony deep mediastinal structures. Surgeons who receive patients who require redoing cardiac surgery after adhesive-enhanced closure with Kryptonite can be reassured that sternal reentry is safe and feasible...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28602219/tranexamic-acid-leads-to-paradoxical-coagulation-changes-during-cardiac-surgery-a-pilot-rotational-thromboelastometry-study
#13
Rajiv Sharma, Hayley L Letson, Samuel Smith, Geoffrey P Dobson
BACKGROUND: Tranexamic acid (TXA) is increasingly used during major surgery with the goal to reduce excessive bleeding, transfusion requirements, and reexploration. Our aim was to examine the effect of TXA on coagulation at different times during cardiac surgery using rotational thromboelastometry. MATERIALS AND METHODS: Nineteen adult males (EuroSCORE 4-5) were recruited consecutively for first-time cardiopulmonary bypass (CPB) surgery. Ten patients received TXA at anesthesia and nine received no TXA...
May 8, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28598874/transverse-split-sternotomy-a-mini-invasive-approach-for-repair-of-congenital-cardiac-defects
#14
Pankaj Garg, Arvind Kumar Bishnoi, Kartik Patel, Chandrashekaran Annanthnarayan, Jigar Patel, Malkesh Talsariya, Komal Shah, Sanjay Patel
OBJECTIVE: In this article, we aim to review our mini-invasive technique of transverse sternal split (TSS) with or without cervical cannulation for cardiopulmonary bypass (CPB), its usefulness, and efficiency for repair of congenital cardiac defects. METHODS: Between January 2013 and June 2015, 34 infants and small children were operated through TSS in third or fourth intercostal space [Tetralogy of Fallot 11, perventricular ventricular septal defect (VSD) device closure 23]...
July 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/28579263/early-and-late-outcomes-with-prolonged-open-chest-management-after-cardiac-surgery
#15
Joshua K Wong, Devang J Joshi, Amber L Melvin, Christopher T Aquina, William J Archibald, Alcina K Lidder, Christian P Probst, Howard T Massey, George L Hicks, Peter A Knight
OBJECTIVES: Open chest management (OCM) is an important intervention for patients who are unable to undergo sternal closure after cardiac surgery. This study reviews the factors associated with a prolonged need for this intervention and investigates its association with early and late mortality. METHODS: Patients undergoing OCM from January 2009 to December 2014 were reviewed. Differences in the median duration of OCM when a perioperative variable was present versus its absence were determined and variables significant at P ≤ ...
September 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28469888/an-alternative-technique-to-safely-close-the-chest-after-placing-a-child-on-central-venoarterial-extracorporeal-membrane-oxygenation
#16
Dimitrios Bobos, Meletios A Kanakis, Sofia Koulouri, Spyridon Rammos, Andreas Karabinis, Nicholas M Giannopoulos
Central venoarterial (VA) placement of extracorporeal membrane oxygenation (ECMO) is performed surgically, and in the majority of cases, the patient remains with an open sternum. Herein, a case of a 3-year-old patient who underwent insertion of a central VA ECMO for heart failure due to acute myocarditis is described. An alternative technique for ECMO placement providing sternal closure and minimizing infection risk for the safe patient transport is described.
May 2017: Clinical Case Reports
https://www.readbyqxmd.com/read/28458765/right-ventricular-perforation-from-a-floating-rib-following-deep-sternal-wound-infection-debridement-and-application-of-a-vacuum-assisted-closure-device-a-case-report-and-literature-review
#17
Amanda J Ross, Nada N Berry
Introduction: Deep sternal wound infection following major cardiac surgery is a deleterious complication with sequelae that can be life threatening. The use of vacuum-assisted closure therapy in management of sternal wounds with resultant right ventricular rupture has been documented in the cardiothoracic and to a lesser extent in the reconstructive literature. Methods/Case Report: We present a case of a 67-year-old male patient who suffered from right ventricular perforation from a floating rib following debridement of a deep sternal wound infection and placement of a vacuum-assisted closure device...
2017: Eplasty
https://www.readbyqxmd.com/read/28434547/stress-dose-corticosteroid-versus-placebo-in-neonatal-cardiac-operations-a-randomized-controlled-trial
#18
Pertti K Suominen, Juho Keski-Nisula, Tiina Ojala, Paula Rautiainen, Timo Jahnukainen, Johanna Hästbacka, Pertti J Neuvonen, Olli Pitkänen, Jussi Niemelä, Anu Kaskinen, Jukka Salminen, Risto Lapatto
BACKGROUND: Corticosteroids can improve the hemodynamic status of neonates with postoperative low cardiac output syndrome after cardiac operations. This study compared a prophylactically administered stress-dose corticosteroid (SDC) regimen against placebo on inflammation, adrenocortical function, and hemodynamic outcome. METHODS: Forty neonates undergoing elective open heart operations were randomized into two groups. The SDC group received perioperatively 2 mg/kg methylprednisolone, and 6 hours after the operation, a hydrocortisone infusion (0...
April 20, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28402472/direct-sternal-administration-of-vancomycin-and-gentamicin-during-closure-prevents-wound-infection
#19
Martin Andreas, Moritz Muckenhuber, Doris Hutschala, Alfred Kocher, Florian Thalhammer, Paul Vogt, Tatjana Fleck, Guenther Laufer
OBJECTIVES: Deep sternal wound infection is still a major complication in patients undergoing cardiac surgery. We previously identified mammary artery harvesting as a risk factor for decreased antibiotic tissue penetration. In addition, other risk factors including diabetes may inhibit sufficient tissue penetration of perioperative antibiotic prophylaxis. A novel closure protocol applying 2 topical antibiotics and further recommendations for sternal wiring was introduced at our department to decrease the incidence of sternal wound infections...
July 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28376028/a-national-study-of-the-impact-of-delayed-flap-timing-for-treatment-of-patients-with-deep-sternal-wound-infection
#20
Erika D Sears, Adeyiza O Momoh, Kevin C Chung, Yu-Ting Lu, Lin Zhong, Jennifer F Waljee
BACKGROUND: This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection. METHODS: The authors analyzed the Truven MarketScan Databases from 2009 to 2013 to identify adult patients who developed deep sternal wound infection after open cardiac surgery and who underwent flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing...
August 2017: Plastic and Reconstructive Surgery
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